Low LAD's - please please help with advice!!

simone

21 Posts
Reply Posted on: Feb 6, 2015 at 4:53pm
Hi there,

I am in Australia and just got my results from the testing done over there in the USA. I would really really appreciate your input as I have been struggling for a few years now and have diminished egg reserve so feel like I am running out of time!

I have had 3 chemical pregnancies in 9 months, and they got earlier each time (30 days, 27 days, 26 days) then nothing - no BFP in over a year.

To give you overview - My NK assay says:
- 50:1 - 29.5%
- 25:1 - 26.4%
- 12.5:1 - 22.3%

CD3 = 72.8%
CD19 = 4.9%
Cd 56 = 19.5 %
CD19+, cd5+ = 4.3%

My TH1/TH2 ratios are: TNFa: IL10 = 16.6
IFNg: IL-10 = 13.3.

My LAD Panel says - flowcytometry negative.

T - IGM - 2.3%
T- igG - 6.1%
B- IgM- 7.7%
B- IgG- 1.5%


I fear this are very very low. Do you know if LIT will bring them up very much? I am on IVIG this month trying naturally and am in the 2 week wait, but would love to know your thoughts! Also, is there any risk of GVHD with LIT (my grandfather died of this after a blood transfusion so am nervous about it)?


My KIR genotype says Bx. I have Inhibitory genes: 2DL1, 2DL2*001/2/3/5, 2DL3, 2DL4, 2DL5, 3DL1, 3DL2, 3DL3. I also have the activating genes: 2ds2, 2DS3, 2DS4, 2DS4 * deletion Ex5, 2DS4*full length, Ex 5, 3DS1.

Is Bx different to AA type which is bad for implantation? I don't think we have any matches, but me being homozygous on DQalpha could lead to me not recognising the fetus as something different to me perhaps? Would you think Neupogen might be needed for me?

Our HLA's:
DQA1: Me: 01:01 homozygous, HIM: 02:01, 05:01
DQB1: Me: 05:01, 05:03. HIM : 02:01, 02:01
HLA-A: Me: 03:26 HIM: 01:29
HLA-B: Me: 27:35 HIM: 08:44
HLA-C: Me: 01:04 HIM: 07:16
DRB3: Me: 02:02:01G HIM: 01:01:02G
DRB4: Me: not tested (not expected to be present) HIM: 01:01/03/06
DRB5: Me: negative HIM: Not tested

If you are still reading this - I have no autoimmune factors (no RF, Anti-thyroid, lupus etc) found and ANA, aPA are negative. I have homo MTHFR and PAI- 1 4g/5g. My uterus and ovaries appear normal from saline Hycosy and I ovulate every month around day 12-14 with 26 day cycle. I have thin lining issues though 7-8mm at ovulation. Thanks so much in advance! Any assistance or pearls of your wisdom would be so much appreciated!

Dr. Braverman

2026 Posts
RE: Low LAD's - please please help with advice!! Posted on: Feb 7, 2015 at 9:57am
First it appears you are taking a very complicated field of immunology and far over simplifying it.
LAD testing is of no value and no need to " correct" any abnormallity you see with it(see my blog on this)
TNF/IL10 ratios are of no value as they are not the true indicators of TH1 responses , here the denominator must be IL4 not IL10 and you need to look at all of the ratios of all of the immune cells for a complete analysis(see our immune testing protocol and our sample reports)
Your HLA data show no issues with incompatablity with your husband but yours alone do show some predispostion to auto immune issues.
The NKa is elevated and this is only one piece of information that by itself does not give you enough for a complete diagnosis.

I would be happy to assist you in your care, you would need to fill out a consutlation request from the website and we can schedule a free 10 minute chat to reveiw. I do not think you should do LIT .
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

simone

21 Posts
Reply RE: Low LAD's - please please help with advice!! Posted on: Feb 7, 2015 at 4:35pm
Thank you so much for your time! I will schedule the 10 minute chat, but I am upset that I wouldn't be able to have full testing done to check other more comprehensive things such as the TNF: IL4. I paid a lot of money to have testing done in Chicago from Australia (over $2500AUD already) as this is the place my Reproductive Immunologist sends to. Is there any way to have the testing done that you would require to make a more accurate assessment?

Also, do you think there is any issues with my KIR genes? Would you suggest Neupogen might be helpful or not helpful in my case?. As you said we don't have HLA matches, but I am homozygous on dQ alpha for 101 which means my body might not recognise the fetus as different perhaps? Or is there any issues with the KIR genes that may affect implantation in which neupogen may help? I am sorry to ask more questions here, but I know it will be a while before my 10 minute consult can be done!

Thanks again so very much!!!

Dr. Braverman

2026 Posts
RE: Low LAD's - please please help with advice!! Posted on: Feb 8, 2015 at 7:04am
Yes we can order the testing for you at our lab. the DQ alpha match is of no signficance (please read my blog on HLA) . Fill out the consult request and we will schedule a free 10 minute skype or phone chat to discuss.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

simone

21 Posts
Reply RE: Low LAD's - please please help with advice!! Posted on: Feb 8, 2015 at 12:01pm
Sorry, but do you think I have any KIR issues that might cause issues with iplantation? I am about to start an IVF cycle so would love your thoughts on this...

Dr. Braverman

2026 Posts
RE: Low LAD's - please please help with advice!! Posted on: Feb 10, 2015 at 6:48am
I would not start any IVF cycle until you have had a full analysis. KIR are certianly an issue but rarely the most important when it comes to implantation failure.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.